Top of the Podium

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When my attending stepped out of the room, the patient looked to me and asked, as many do, “How far along are you in medical school?” She was a sharply-dressed woman in her mid-eighties whose cane hardly slowed her down from flying in from Chicago that morning after visiting her grandchildren. Before I could answer her question, however, she remarked, “Oh, you are just so lucky! When I was your age, becoming a doctor wasn’t even a possibility that entered my mind. I was a nurse, but I always thought if I’d had that opportunity I would have made a great doctor.” As she went on to tell me how proud she was of her grandchildren who were pursuing higher education and wish me luck and encouragement in my studies, I was reminded again of how much I take for granted being raised in a world full of opportunity.

As this patient reminded me, women have opportunities today that those only a generation or two before us couldn’t fathom, and we are taking advantage of many of these opportunities. In 2011, for example, 48% of medical school graduates were women; compare this to 30 years ago, when only 27% of graduates in 1983 were women.1 Despite the fact that we are training more female doctors, however, these trends have not translated to healthcare leadership: only 18% of hospital CEOs and 4% of healthcare company CEOs are women.2  Why is this so? While the barriers to career advancement for females in healthcare are many, I’d like to focus on the most commonly cited by the 2011 Rock Health Survey of women in healthcare: self-confidence.2

Facebook COO and Lean In author Sheryl Sandberg speaks to this barrier in her 2010 TED Talk where she focuses on what we can do as individuals to increase the representation of women in leadership positions. Using an anecdote about a class she took in college with her female roommate and her brother, she describes the tendency of males to exude confidence and attribute their successes to themselves, while females tend to attribute their successes to external factors including co-workers and luck.

Hearing this story reminds me of the ways I have come to witness this feature of the female psyche manifest in both myself and fellow female competitors at the CrossFit Games.

CrossFit as a whole has treated male and female athletes with equal respect and opportunity from its inception.3 Workouts of the Day (WODs) posted on CrossFit.com do not include scaling options for females or any other subset of the CrossFit community, suggesting that individuals may chose to scale appropriately but should not feel limited in any way, for example by age or gender. 40% of this year’s CrossFit Games Open participants were women, and on any given day one can expect to drop into a local CrossFit affiliate to find women besting men in workouts involving deadlifts, cleans, pull ups, and the like. CrossFit’s dedication to providing equal opportunities regardless of gender also extends beyond the WOD. Hope for Kenya mobilizes the CrossFit community to raise money to build water cisterns which free Kenyan women from their duties of traveling miles for fresh water each day. In doing so, young girls are provided the opportunity to pursue education and a brighter future. As the Sport of Fitness, the CrossFit Games, has experienced exponential growth over the past several years, it has also continued to provide equal opportunities for competitors of both genders. Prize money, now totaling well over $1 million is distributed equally among male and female competitors, and the number of segments featuring CrossFit Games events on ESPN2 are also gender-equal. Events including 2012’s Pendleton triathlon and 2013’s Pool and Row have also allowed male and female competitors to compete alongside one another, performing the same work.

Despite the abundant opportunities we have as female CrossFit athletes, natural differences between the male and female fields of competitors remain. While it seems that hard work, dedication, and talent should be the only factors distinguishing those who stand on the podium from those who do not, from my own experience and that of my peers, sport is another place where self-confidence can become our greatest barrier to success. Similar to Sheryl Sandberg’s story, a quick sampling of athlete profile videos on the CrossFit Games site will demonstrate that male competitors are more likely to outwardly express their desire and belief in their ability to win. Female competitors, on the other hand, are more likely to state that they “just want to do their best” or are simply happy to have the opportunity to compete. It comes as no surprise that the female athletes who do exude self-confidence and a belief in their ability to win including two-time champion Annie Thorisdottir, 2013 champion Sam Briggs, and 2013 runner-up Lindsey Valenzuela find themselves successful.

So why is it that women frequently lack confidence in their ability to succeed? Perhaps it’s a fear of vulnerability, not wanting to feel disappointed by falling short of a goal. As Sheryl Sandberg suggests, perhaps it’s a fear of not being well-liked, as research shows that successful women are far less likely to be well-liked than their successful male counterparts. Maybe, as Elisabeth Akinwale suggests, it’s a struggle to strike a balance between the virtues of humility and confidence. Self-confidence has been my own downfall as a CrossFit Games competitor in the past, and I can attribute its lacking to each of these reasons to some degree. Examining my career as a medical student thus far, I find similar instances where I wonder whether my own self-confidence has limited my performance. Most recently, for example, I was happy to receive a USMLE Step 1  score that exceeded the goal I had set for myself months ago – but what if I’d had the confidence to set that initial goal higher?

So, knowing all of this, what can we as individual women do about it? We are privileged to live in a generation where opportunity is abundant. There are too many other barriers to success in life to allow a lack of self-confidence to be one of them. This year, I’m vowing to set my sights on the top of the podium at the CrossFit Games. Sure, I might fall short, but if I do, I’ll know that it was because of my physical performance and not because of a lack of belief in myself. So, ladies, whether it’s looking toward the top of the podium, a stellar exam score, a career change, or a job promotion, let’s set our goals high this year and refuse to allow a lack of belief in ourselves to hold us back. Who’s with me?

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2012 CrossFit Games

This post was inspired by XX in Health Week, celebration of female leadership

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  1. AAMC U.S. Medical School Applicants and Students 1982-83 to 2011-2012. https://www.aamc.org/download/153708/data/
  2. http://xxinhealth.org/reports/
  3. http://journal.crossfit.com/2013/07/a-mandate-and-an-opportunity.tpl

Perspective

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Whether I was watching 60-year-olds fight their way through events that would leave 20-year-olds gasping for breath, demonstrating events for the competitors alongside legends that inspired me to start my own CrossFit journey four years ago, or offering a quick “Good luck” to someone who had been a rival a year ago, the perspectives offered by my experiences at the 2013 Reebok CrossFit Games are irreplaceable.

CrossFit Games Masters Competition
CrossFit Games Masters Competition

I’d be lying to say that I didn’t feel a tinge of sadness over the course of the week or shed a tear or two behind my oversized sunglasses, but between those fleeting moments I was overwhelmed with a feeling of celebration.  Along with the impressive contingent of fans, volunteers, vendors, and support staff I celebrated the hard work of the CrossFit Games athletes and their representation of the Sport of Fitness. I sat back and once again reveled in this amazing movement called CrossFit and how it has changed all of our lives.

Having fun with the "Research + Demo" team
Having fun with the “Research + Demo” team

As I watched Saturday evening’s “2007” event unfold from temporary stands added to the top of the tennis stadium, I was struck by the quality of the view. I’m not sure what I was expecting – I had never actually watched an event from the stands of the StubHub stadium before, but for some reason I imagined that I would feel distant from the competition. However, even from these makeshift seats added due to the overwhelming demand for tickets, I felt close to the stadium floor. I could see the athletes progress through each round of pull-ups on Rogue’s A-frame rig setup.  I noticed their technique – beautiful butterfly pull-ups, the visible differences in limb lengths, and some athletes even using regular kips that were faster than the butterflies of their peers.  I watched and learned from these athletes who had sacrificed all year for this moment.

Not a bad seat in the house for The Cincos
Not a bad seat in the house for The Cincos

Perhaps it was because I had been there myself just a year ago, or perhaps my seat really wasn’t all that far away, but I like to think that watching the CrossFit Games offers a perspective unlike any other sporting event. Whether you are an athlete, fan, or volunteer, CrossFit has changed your life, or at least the life of someone close to you. As I encountered individuals in various volunteer, staff, and vendor roles throughout the week, I observed a common thread – although all were working incredibly hard and I could see hints of stress and fatigue on their faces, their happiness and passion for making the event a success was overwhelming. It was clear that there was no place in the world that these people would rather be than at the CrossFit Games, working hard as they do every day in their own boxes around the world.  Each of these individuals plays an integral role in making the CrossFit Games a true celebration – not only of the athletes in the stadium, but of those filling the stands, changing the equipment, and taking the photos and videos. After all, it’s  these athletes and this community that supports and inspires the athletes on the floor to expand the boundaries of human potential each year.

Sitting among family, friends, and fellow athletes as I viewed the CrossFit Games from many different perspectives this year, I realized that although the perspective of competitor is most reveled, when you’re with this community, there is truly not a bad seat in the house.

Perspective is both necessary and sufficient ground for wisdom. – Jonathan Lockwood Huie


How CrossFit Prepared Me for the USMLE Step 1

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We talk all the time about how our experiences inside the four walls of the CrossFit box translate to life outside, but never has this truth been so glaringly apparent to me  as in my preparation for the USMLE Step 1 board exam.  As the hours, days, and weeks of flashcards, Qbanks, and practice exams dragged on, I couldn’t help but notice the ways in which my CrossFit training had prepared me for this intellectual challenge. Reflecting on this experience, I’ve collected the top 12 reasons why CrossFit prepared me for the task of studying for and taking the USMLE Step 1 exam:

A great motivator for any task: The Clock
A great motivator in many aspects of life: The Clock
  1. Success is born from routine, structure, and commitment. Expecting your test score to jump 50 points or to get a muscle up in one day is unrealistic – these improvements come from sustained, regular practice and small improvements over time.
  2. Though we may find more enjoyment in practicing what we’re good at, the greatest overall improvements will come from working on our weaknesses. If you’re much more comfortable with Olympic lifting than gymnastics, the best way to improve your overall fitness is by spending more time on gymnastics skills. If you’re confident with Cardiology topics but Neurology makes you want to have a panic attack, the greatest improvement in your overall score will result from studying Neurology.
  3. If you put in the work, you will see measurable improvements. AMAZING.
  4. Studying is like an AMRAP. If you start your day thinking about how you have 12 hours to go, you will feel overwhelmed and defeated. Focusing on making each repetition perfect, answering each practice question to the best of your ability, will allow you to stay in the moment. Before you know it, the timer will “Beep” and your AMRAP will be over.
  5. Time worrying about what everyone else around you is doing is time wasted. How much time your friend spent in the gym or what his score was on the workout is just as irrelevant as how many hours your classmate spent studying or what she scored on her practice exam. What IS important is YOU and that you are sticking to your plan, working hard, and seeing improvements in your own performance.
  6. There is no greater motivator than the clock. The clock is guaranteed to increase your power output whether it may be physical power or brain power. Use the clock to set a timeline and stick to it – tasks will always fill the time you allot them.
  7. When times get tough, you can always trick yourself into doing more work with a TABATA interval. Increased intensity = Increased power output. Scheduled breaks are necessary to allow yourself to reset.
  8. Scores are a great way to motivate and track progress, but your performance in any single workout, or on any exam, does NOT define you. What defines you is the type of person you choose to be and how hard you work with the tools  you have available.
  9. Practice the way you compete. Doing a workout with questionable range of motion in training will only prepare you for “no reps” on the competition floor. Taking a practice exam with longer breaks, in a comfortable environment, while sipping your coffee is not going to prepare you ideally for the test day environment.
  10. When you’re on hour 6 of 7 of your exam and you just want to give up, you can always draw from your experience on round 6 of the Sevens when you felt the same way. In that workout you were able to able to dig deep and push through to the end, so this exam should be no different. The feeling of achieving a goal after questioning whether you would be able to is unmatched.
  11. Your potential in any endeavor will be maximized by relying on your support team. Whether it’s your mother coaxing you out of bed to study at 7 AM with freshly brewed coffee, your coach pushing you through a workout when you are near your breaking point, or your friends who work, sweat, laugh, and cry with you, surround yourself with people who will make you better.
  12. Each day is new. No single workout, no single set of practice questions matters. What matters is the cumulative effort and hard work sustained over time.
The right support team is crucial in shouldering any task
The right support team is crucial in shouldering any task

Reflections on Scenes from Wit

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A little over a week ago, I attended the third annual Cleveland Clinic Lerner College of Medicine (CCLCM) Research Day. This afternoon serves to highlight and celebrate the research of our recently-matched and ready-to-graduate fifth-year students and also brings together nearly all 160 CCLCM students and numerous faculty for a lecture in memory of Iva Dostanic MD, PhD, CCLCM Class of 2011. This year’s lecture strayed from a traditional research presentation in order to feature scenes from the 1999 Pulitzer-prize winning drama Wit, interspersed with narrations by its author Margaret Edson. For a little over an hour I watched the unraveling of the play’s lead character Vivian Bearing, a renowned English professor being treated in a research hospital for stage four ovarian cancer. As we witnessed the juxtaposition of characters clinging to their professional identities of professors, physicians, and scientists with the slowly increasing exposure of Professor Bearing’s vulnerability, Margaret explained her motivations for crafting the play in such a manner. She explained how she envisions every person to have three different “selves.” First, we have a busy self – this is the self that most people identify with for the majority of their lives. This busy self is the self that is doing, accomplishing, earning, pleasing – creating and maintaining an identity recognized by the outside world. Margaret refers to our physical self as our slimy self – most of the time this self operates on its own, and in the case of a malfunction doctors and scientists are tasked with its repair. Margaret finally describes the true self, the self that remains when one day both the busy self and the slimy self have gone. She describes that for most individuals, the busy self predominates; however, in brief moments we are afforded a glimpse of our true selves.  In Wit, Margaret strips Professor Bearing of both her busy self and slimy self – confined to a hospital bed with scientists bustling about her as if her body is nothing more than a research specimen, Professor Bearing fights to cling to her busy self identity until at last, in the final scenes before her death, she relents and allows the exposure of her true self.  In her narration, Margaret describes the necessity  of this terrible struggle in order for Professor Bearing to experience her true self, if even for only a few moments before her death. Painful as it was to watch Professor Bearing’s suffering in these final moments, Margaret argues that it would have been far more tragic had she died according to her own heroic dream- reaching for a book on the top shelf at the library – having never been challenged to discover and embrace her true self.

Professor Bearing clings to her "busy self" identity while surrounded by physicians and scientists assessing her "slimy self."
Professor Bearing clings to her “busy self” identity while surrounded by physicians and scientists assessing her “slimy self.”

As I reflect on this performance and some recent discussions I’ve had, I realize how closely this dramatization resembles the experience of most individuals in our culture. We proceed through life so preoccupied with our busy selves that it often requires a wake up call in the form of a threat to our busy selves  (losing a job or particular role we play) or our slimy selves (an illness) for us to stop and spend a few moments connecting with our true selves. Even in this situation, we often we grasp for our busy or slimy self identities to prevent the exposure of our true selves. I can’t imagine how frightening such a dramatically life-changing event must be on its own, but facing this event while simultaneously meeting one’s true self for the first time would likely prove much more disorienting and overwhelming, in my mind.

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Margaret Edson narrates scenes from Wit, her Pulitzer-prize winning play at the 2013 CCLCM Research Day.

So, how can we try to touch base with our true selves prior to such an event so that we may be better prepared to handle the threats to our busy or slimy selves that will undoubtedly ensue? One approach lies in distracting our other selves such that we permit our true selves to shine through, and I’d like to propose the argument that walking into a CrossFit affiliate allows us to do just that. One of the many reasons I love walking into a CrossFit affiliate is that entering inside those four walls forces us to abandon our busy selves. Inside a CrossFit affiliate, no one knows or cares whether you are a world-renowned physician, researcher, English professor, mother, musician etc – all that matters is that you are there, ready to work hard to move better, improve your fitness, and support those around you to do the same.  While normally we cling to our busy identities, a CrossFit affiliate provides a safe space for us all to let go and take on the identity of an athlete.  While it may be true that CrossFit forces us to focus on our slimy (or physical) selves through exercise, I’d like to propose that by taking our bodies to the limits of their capabilities as we do in CrossFit, we lose the ability to maintain complete control over our slimy selves, and this effort transcends the physical to the mental and emotional.  Any CrossFitter can identify with a moment when your body has failed, forcing you to stand gasping for breath over your barbell near the end of a workout. You have 5 reps left, and you’re starting to question whether you will finish. You can hear the words of encouragement from your trainer and peers somewhere off in the distance, and in that moment you make the decision to step back to your barbell and keep forging ahead. It is in these moments, which happen every single day in CrossFit affiliates around the world, that individuals are stripped of their so-called busy and slimy selves and stand face-to-face with their true selves.

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Professor Bearing starts to expose her “true self” while speaking with her nurse.

It is in a brief moment in Wit when Professor Bearing connects with her research resident that ultimately  allows her to begin to expose her true self.  In her narration, Margaret emphasizes the importance of human connection in discovering our true selves in the midst of the chaos of our lives, a theme we are again no stranger to in the CrossFit community. Not only does CrossFit strip us of our busy and slimy selves, but it allows us to do so in the presence of others, facilitating the connection with our fellow human beings and thus allowing us to make sense of our crazy, chaotic lives.

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Dr. Martin Kohn, Director of the CCLCM Program in Medical Humanities, Scenes from Wit Director Katherine Burke, Actor Prof. Catherine Albers, and Playwright Margaret Edson reflect on the Scenes from Wit performance.

By providing this opportunity, CrossFit regularly forces us to ask our true selves questions such as “Who am I?”, “What am I made of?”, and “How am I going to approach the challenges that life brings?” As we gain this insight, we are better equipped to embrace our true selves and more fully understand the meaning and purpose of our lives. When faced with a threat to our busy or slimy selves in the future, such an understanding of our true selves will better prepare us to face these challenges with resilience and grace.

Thank you to Laureen Nemeth for the photos used in this post.